婦女孕前肥胖對於孕期情緒之影響：孕期與增重之角色為何?

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题名:	婦女孕前肥胖對於孕期情緒之影響：孕期與增重之角色為何? The Link between Maternal Pre-pregnancy Obesity and Prenatal Emotional Status: What is the Role of the Trimester and Gestational Weight Gain?
作者:	梁立人 Liang, Li-Jen
贡献者:	陳怡樺
关键词:	婦女孕前身體質量指數,外表接受度,孕期憂鬱,孕期焦慮 pre-pregnancy body mass index,body image acceptance,prenatal depression,prenatal anxiety
日期:	2013-06-11
上传时间:	2018-09-27 14:29:03 (UTC+8)
摘要:	目的：過去研究發現肥胖與憂鬱有關，但結果在不同族群中不太一致，且較少研究針對孕前BMI來探討孕期情緒問題之影響，所以本研究旨在瞭解懷孕婦女孕前BMI及孕期憂鬱焦慮現況，並進一步探討婦女孕前BMI、孕前BMI及外表接受度與孕期憂鬱及焦慮之關係以及之中的關係是否會被孕期增重及孕期修飾。方法：本研究為橫斷式研究，於2011年7月到2013年3月收案，以立意抽樣法選擇台北市以及新北市四間醫學中心以及教學醫院婦產科門診，共收有1000名第二及第三孕期懷孕婦女。問卷以「愛丁堡產後憂鬱量表(EPDS)」和「情境焦慮量表(STAIS)」測量憂鬱與焦慮情況，孕前BMI分為四組，分別為過輕(BMI < 18.5)、正常(18.5 ≤ BMI < 24)、過重(24 ≤ BMI <27)及肥胖(BMI≥27)。為了探討婦女孕前BMI與外表接受度的影響，本研究將婦女孕前BMI和外表接受度合併分為四組，分別為「體重正常且能接受」、「體重正常但不能接受」、「體重不正常但能接受」以及「體重不正常且不能接受」。隨後會進行描述性統計、修飾因子的檢驗、雙變項分析及多變項邏輯斯迴歸分析。結果：在雙變項分析中發現，孕前體重和孕期憂鬱焦慮沒有顯著差異，但是當孕前BMI和外表接受度合併時則和孕期憂鬱與焦慮有關。在憂鬱的多變項分析時發現，相較於孕前BMI正常且能接受外表，孕前BMI正常但不能接受外表會有較高的孕期憂鬱危險性(OR=3.44, p<0.01)，接著在孕期增重分層下發現，增重正常組且孕前BMI肥胖會有較低的孕期憂鬱危險性(OR=0.31, p<0.05)，但孕前BMI正常但不能接受外表無論增重量多少，都會有較高的孕期憂鬱危險性(增重正常：OR=3.36, p<0.001; 增重過多：OR=5.70, p<0.01)。在焦慮的多變項分析時，調整其他干擾因子後，相較於孕前BMI正常且能接受外表，孕前BMI正常但不能接受外表(OR=6.25, p<0.001)及孕前BMI過重且不能接受外表(OR=16.95, p<0.01)皆有較高的孕期焦慮危險性，接著在孕期分層下發現第三孕期孕前BMI肥胖會有較低的孕期焦慮危險性(OR=0.34, p<0.05)，但孕前BMI正常但不能接受外表無論第二孕期(OR=5.21, p<0.01)或是第三孕期(OR=8.32, p<0.001)皆發現會有較高的孕期焦慮危險性，且第三孕期的危險性高於第二孕期。結論：本研究發現，懷孕時期有很高的孕期憂鬱焦慮盛行率，孕前BMI較高會有較低的孕期憂鬱焦慮危險性，而孕前BMI正常但不滿意外表則有較高的孕期憂鬱焦慮危險性。孕期憂鬱及焦慮的修飾因子不同，憂鬱的部分發現不同的孕期增重其孕前BMI肥胖對於孕期憂鬱危險性不同，焦慮的部分則是發現不同孕期孕前BMI肥胖對於孕期焦慮危險的方向性不同。本研究未來可提供醫護人員臨床實務做參考，藉由體重監控以及憂鬱焦慮篩檢找出高危險群，盡早預防及介入，期能有效提升產婦健康及未來胎兒的成長與發育。 Background: Prenatal depression, affecting 9%-38% of women, is one of the most important issues in maternal and child health. Previous studies have investigated the association between pre-pregnancy obesity and postpartum depression. However, very limited findings focused on the link between pre-pregnancy obesity and prenatal emotional disturbances. Almost none has explored the effects of body image, together with obesity, during pregnancy. This study was thus aimed to examine the association between maternal pre-pregnancy obesity (combined with body image) and prenatal depression/anxiety. The potential moderating effects of gestational trimester and weight gain would further be examined. Methods: A total of 1000 women were recruited as they attended prenatal visits from July 2011 to March 2013 in four selected hospitals in Taipei City and new Taipei City, Taiwan. Self-reported questionnaires were administered in the hospitals, including the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI) for the assessment of prenatal depression and anxiety, respectively. The pre-pregnancy body mass index (BMI) was calculated as the body weight (kg) divided by the height squared (m2). The continuous distribution of BMI was also categorized into 4 groups (i.e., underweight, normal weight, overweight, and obesity). To further investigate the effects of pre-pregnancy BMI combined with body image acceptance, four groups were generated, including normal weight/acceptable body image, normal weight/unacceptable body image, overweight/acceptable body image, and overweight/ unacceptable body image. Descriptive, bivariate and multivariate regression analyses were performed for examination. Result: In bivariate analysis, we found a null relationship between pre-pregnancy BMI and prenatal depression and anxiety. However, pre-pregnancy weight status combined with body image acceptance was associated with prenatal depression and anxiety (p=<0.0001). In multivariate analysis, we observed an increased risk of prenatal depression among women with normal weight/unacceptable body image (OR=3.44, 95%CI=1.91-6.17), compared to women with normal weight/acceptable body image status. Stratified analyses were further performed by gestational weight gain. For those with adequate weight gain, pre-pregnancy obesity might decrease the risks of prenatal depression (OR=0.31, 95%CI=0.10-0.95). Nevertheless, women with normal weight and unacceptable body image might experience higher risks of prenatal depression, for those with both adequate weight gain (OR=3.36, 95%CI=1.68-6.72) and excess weight gain (OR=5.70, 95%CI= 1.43-22.71). In terms of multivariate analysis for anxiety, compared to women with normal weight/acceptable body image, those with normal weight/unacceptable body image (OR=6.25, 95%CI=3.23-12.11) and with overweight/unacceptable body image (OR=16.95, 95%CI=2.12-135.48) might experience increased risks of prenatal anxiety, after adjusting for other covariates. In further stratified analysis by trimester, we found that women with pre-pregnancy obesity might decrease the risks of prenatal anxiety in the third trimester. However, women with normal weight but unacceptable body image might increase the risks of prenatal anxiety both in the second (OR=5.21, 95%CI=1.80-15.07) and the third trimester (OR=8.32, 95%CI=3.31-20.96). Conclusion: Considerably high prevalences of prenatal depression and anxiety were found in our study. While women with prenatal overweight/obesity might decrease the risks of prenatal depression and anxiety, those with normal weight but unacceptable body image might experience elevated risks of perinatal depression and anxiety. Modifying effects of gestational trimester and weight gain should be considered carefully. Our study would provide important implications. Weight gain monitoring and depression/anxiety screening during pregnancy may help identify higher risk groups at maternal prenatal visits. Prevention and intervention programs may thus be designed and implemented to promote maternal mental health during the critical period of pregnancy.
描述:	碩士論文指導教授-陳怡樺委員-楊浩然委員-陳品玲
数据类型:	thesis
显示于类别:	[公共衛生學系暨研究所] 碩博論文

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